Chronic illnesses, including non-communicable diseases such as diabetes and communicable diseases such as HIV, are increasingly intersected with high rates of common mental disorders (CMDs). An integrated response where mental health screening and care occurs within chronic disease care is increasingly recognized. We explored the experiences of chronic disease patients in South Africa of a lay health worker (LHW)-delivered psychosocial intervention based on motivational interviewing (MI) and problem-solving therapy (PST) to reduce heavy drinking and depression. We conducted 28 interviews with patients taking antiretroviral therapy (ART) for HIV or medication for diabetes; who screened positive for hazardous drinking and/or depression and completed 1-4 counselling sessions. Patients were recruited from 16 primary care clinics in the Western Cape province of South Africa. Interviews included discussions on patient’s experiences leading to their enrollment in the programme, and of the counselling sessions and quality of interaction with the counsellor. Qualitative data were analysed using the framework approach. Findings suggest that counselling for CMDs was a catalyst for acceptance of chronic disease which in turn had a positive impact on adherence. Furthermore, intervention components that built resilience and developed coping strategies were most beneficial. The findings confirm acceptability of a LHW-delivered MI-PST counselling within chronic disease care and services and the results support the effectiveness of the intervention which could be further enhanced by including ongoing peer support within the healthcare setting.